Grefe syndrome

The setting sun symptom is a pathology that can occur at any age. Let's consider the features of the syndrome, symptoms, diagnostic methods and treatment.

The disease was first described in the nineteenth century by the German ophthalmologist Albert Graefe. The scientist studied the condition of bilateral paralysis of the eye muscles, which occurs due to the degeneration of nerve cells. This causes limited mobility of the gaze, dilated pupils, abnormal head position and other pathological symptoms. The scientific and medical name of the disease is hydrocephalic syndrome (HCS). It is associated with excessive accumulation of cerebrospinal fluid in the ventricle of the brain or under its membranes.

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Causes of Grefe syndrome

Hydrocephalic disorder indicates a pathological condition of the brain. The causes of Graefe syndrome are associated with congenital or acquired factors that affect the baby's underdeveloped nervous system. Gradually, the central nervous system adapts to the surrounding conditions and the symptoms disappear.

The main causes of pathology:

• Late, premature, complicated labor.
• Pathological course of pregnancy.
• Infectious diseases during pregnancy.
• Chronic diseases of women.
• Hereditary factors.
• Hypoxic condition.
• Ischemia.
• Bradycardia.
• Birth injuries.
• Brain cyst.
• Increased intracranial pressure.
• Metabolic disorders.

In these cases, the child is immediately registered with a neurologist to monitor the clinical picture. If the child is premature, the eyeball defect may persist for a long period of time. In rare cases, HGS occurs in older age due to the accumulation of cerebrospinal fluid as a result of metabolic disorders, craniocerebral trauma, and various infections.

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Pathogenesis

The mechanism of development of the sunset symptom is based on the inadequate functioning of the nervous system. Pathogenesis depends on the cause of the pathological process, which is associated with the accumulation of cerebrospinal fluid. Cerebrospinal fluid accumulates in large quantities due to a malfunction of the system of its production and absorption. The total volume of cerebrospinal fluid in the subarachnoid space and ventricles is about 150 ml. During the day, the body produces up to 180 ml of cerebrospinal fluid. 75% of this volume is produced by the vascular plexuses of the ventricles of the brain.

The rate of production depends on the perfusion pressure in the brain (the difference between intracranial and mean arterial pressure). The rate of fluid absorption depends on intracranial and venous pressure. All this indicates instability of cerebrospinal fluid dynamics. An increase in cerebrospinal fluid in the skull may be the result of a balance between its absorption and production or disturbances in its normal outflow.

This pathology is characterized by a white stripe between the iris and the upper eyelid, which is visible when looking down. The syndrome has two varieties:

• It appears when the body position changes and goes away on its own within 2-3 months from the baby’s birth.
• Symptoms do not depend on movement or body position - this condition requires medical attention and careful diagnosis.

To establish an accurate diagnosis, the child is prescribed MRI, CT, neurosonography and other studies. Based on their results, a therapy plan is drawn up (medication, therapeutic massage, physiotherapy). If there is positive dynamics, then this treatment is limited. In more complex cases, the patient will undergo surgical intervention to ensure the outflow of cerebrospinal fluid.

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Symptoms of Grefe syndrome

Most often, the syndrome manifests itself in premature babies, since their nervous system has not yet matured, but it is also possible in healthy babies in the first days of life. In 95% of cases, suspicions are not justified. The main sign of illness is a white stripe of the sclera above the iris under the upper eyelid, which is noticeable when the child looks down. Many doctors are confident that this condition is not dangerous and goes away on its own if there are no additional symptoms. To make an accurate diagnosis, the doctor refers the patient to a number of diagnostic procedures and tests. Based on their results, he gives recommendations for treatment and prevention.

Signs of the disease depend on its cause and the patient's age. Symptoms of Graefe syndrome can appear from the first days of a child's life. As a rule, this is a complex of disorders that confirm the presence of pathology.

Symptoms:

• Weak reflexes in infants (difficulty swallowing, squeezing fingers).
• Weakened muscular system – hands and feet hang down when the child is picked up.
• Frequent attacks of convulsions.
• Pronounced strabismus.
• Frequent regurgitation.

The most important indicator of the development of the disease is nystagmus, that is, involuntary eye movements. This occurs with high frequency and amplitude. Movements are observed both horizontally and vertically, and a strip of the white of the eye is visible above the iris.

Due to insufficient oxygen supply to the tissues as a result of damage to the cardiovascular system, the skin of the extremities and nasolabial triangle turns blue. Vegetative-vascular disorders and problems with blood supply provoke a marbled coloration of the skin. Against this background, the natural regulation of the body is disrupted, rapid breathing appears. Gradually, intracranial pressure begins to rise, and the brain is filled with cerebrospinal fluid. As the child's nervous system matures and strengthens, the production of cerebrospinal fluid normalizes, the fontanelle closes and intracranial pressure normalizes.

In pathological development of pediatric patients, cerebrospinal fluid penetrates into the venous system, causing deafness, blindness, and delays in physical and mental development. Without treatment, the disease can develop into paralysis, coma, or epilepsy.

In adult patients, the symptoms of the syndrome look like this:

• Morning headaches that radiate to the forehead, brow ridge and temples.
• Frequent attacks of nausea and vomiting.
• Dizziness.
• General weakness and lethargy.
• Difficulty lowering the eyes and raising the head.

Due to increased muscle tone in the lower extremities, the patient walks on tiptoes. Drowsiness and squinting appear, the thought process gradually slows down, problems with concentration and memory appear. If this symptom complex is present, it is necessary to immediately seek medical help. It is better to undergo an examination once again than to miss the onset of a serious pathology.

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First signs

The clinical picture of Graefe syndrome depends on the level of increased intracranial pressure (hypertension) and an increase in the amount of cerebrospinal fluid in the brain (hydrocephalus). The first signs appear in the first days of the child's life. Parents note that the baby constantly cries, moans, and does not latch on well. The disease is characterized by the following set of symptoms:

• Decreased muscle tone.
• Tremor of the limbs.
• Weak congenital reflexes: swallowing, grasping.
• Strabismus.
• Frequent regurgitation.
• White stripe between the pupil and the upper eyelid.
• Opening of the cranial sutures and bulging of the fontanelle.
• Increased growth in head circumference (1 cm per month).
• Edema of the optic discs.

In older patients, the disorder manifests itself after an infection or brain injury. The first signs are as follows: severe headaches in the morning, nausea and vomiting. The pain is bursting, dull, localized in the temples and forehead. Patients have difficulty raising their eyes and lowering their heads, and dizziness is possible.

The above symptoms are accompanied by pale skin, weakness and lethargy. Irritability to loud sounds and bright light appears. The syndrome can cause strabismus, slow thinking and attentiveness, drowsiness. Increased muscle tone provokes walking on tiptoes.

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Graefe syndrome in newborns

Frequent throwing of the head back, profuse regurgitation and wandering gaze are signs of Graefe syndrome in newborns. The malaise is associated with increased intracranial pressure and hydrocephalus. The baby suffers from severe headaches, against which strabismus, deafness and deterioration of visual acuity develop.

Very often pediatricians call the problem the "setting sun" symptom. Since the upper eyelid of infants lags behind the iris. This is noticeable when looking down, part of the sclera appears at the top. As a rule, the pathology is diagnosed in premature babies, since the nervous system is not able to control the processes in the eyeballs. But as soon as the nerve cells mature, all symptoms disappear. About 2% of healthy children are born with the syndrome, doctors associate this with a hereditary predisposition and the structure of the eye.

Such children need medical supervision. But if the disorder is accompanied by additional symptoms: pulsating fontanelle, quiet crying, tremor of the limbs, throwing back the head, frequent regurgitation, then the baby is sent for diagnostics and treatment. To detect hypertensive-hydrocephalic disease, MRI, electroencephalography and other studies are necessary. This will determine the presence of deviations and internal tumors.

To prevent further development of the pathology, the patient is prescribed a special massage and other physiotherapy procedures to alleviate the condition. In particularly severe cases, surgical intervention is performed - shunting to remove cerebrospinal fluid.

Graefe syndrome in adults

Hypertensive-hydrocephalic disorder in adult patients develops due to:

• Tumors.
• Neuroinfections.
• Suffered a stroke.
• Traumatic brain injury.

The symptoms of Graefe syndrome in adults are similar to its pathological manifestations in children:

• Severe headaches.
• Visual disturbances (strabismus, double vision).
• Nausea, vomiting.
• Disturbances of consciousness.
• Problems with concentration, memory, mental activity.
• Convulsive seizures.
• Coma.

To establish a diagnosis and prescribe treatment, the patient must undergo a full range of diagnostic procedures. Therapy consists of drug treatment and physiotherapy. With timely medical attention, the disease can be eliminated with minimal complications.

Complications and consequences

Graefe's syndrome, like any other disease left without medical care, can cause serious consequences. Pathological disorders manifest themselves in all organs and systems, most often these are:

• Delayed physical and mental development.
• Incontinence of urine and feces.
• Bulging fontanelle.
• Blindness.
• Deafness.
• Epilepsy.
• Paralysis.
• Coma.
• Death.

These symptoms are possible in patients of any age who have been diagnosed with the disease. The most favorable outcome of the disease is in infants. This is explained by the fact that the increase in blood pressure and cerebrospinal fluid stabilizes as they grow older. In adulthood, the occurrence of adverse effects is more likely, but with timely treatment, the risk is minimal.

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Complications

Diseases associated with disorders of the nervous system in patients of any age entail serious complications. If the syndrome is detected in an infant, there is a chance that as the child grows up, everything will return to normal. But if this does not happen, the disease leads to problems with hearing and vision (strabismus), mental and physical development disorders.

With Graefe syndrome, cerebrospinal fluid may enter the venous system. In this case, epileptic seizures, paralysis, and even coma occur. Many complications occur at advanced stages. To alleviate the patient's condition, shunting is performed to improve the outflow of cerebrospinal fluid. Serious complications can be avoided with timely diagnosis and treatment.

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Diagnostics of Grefe syndrome

Any disorders, both in infancy and in adulthood, require medical supervision. The setting sun symptom is a cause for concern. The defect is characterized by tension and protrusion of the fontanelle, opening of the sutures of the child's skull, swelling of the optic discs, rapid increase in head circumference, frequent attacks of headache with nausea and vomiting, tremor of the limbs. To determine how dangerous this condition is, it is necessary to undergo a medical examination.

• Examination by a neurologist - the doctor studies the development of the head: the level of closure of the sutures, the condition of the fontanelle, changes in the size of the skull.
• Examination by an ophthalmologist - the examination is aimed at examining the fundus of the eye to detect swelling of the optic disc.
• MRI, ultrasound – allow a detailed study of the patient’s condition, causes and stage of the disorder.

Based on the results of these methods, the doctor develops a course of treatment. The duration of therapy and its effectiveness depend on the patient's age, the presence of complications and the severity of HGS.

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Tests

Detection of hypertensive-hydrocephalic syndrome is difficult, since the research methods indicating the level of cerebrospinal fluid pressure are limited. Blood and urine tests are a standard diagnostic set that allows us to judge the general condition of the patient's body. Lumbar puncture of the cerebrospinal fluid is mandatory to measure the pressure. The results of this analysis are a diagnostic criterion for pathology.

The patient is prescribed neurosonography, i.e. a study of the anatomical structures of the brain and the size of the ventricles. The doctor evaluates the condition of the vessels of the fundus. The signs of the disease are: swelling, vascular spasms, plethora, hemorrhages.

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Instrumental diagnostics

To clarify the causes and factors that caused the setting sun symptom, not only standard research methods are used, but also instrumental diagnostics.

Hardware examination consists of:

• Neurosonography is an ultrasound of the anatomical structures of the brain through the fontanelle. It reveals foci of leukomalacia, periventricular hemorrhage and ventriculomegaly.
• Echoencephalography is a study of intracranial lesions and brain activity processes using ultrasound. It has no contraindications, so it can be used for patients from an early age.
• X-ray of the skull – used in advanced stages of the disease. Most often performed on children over one year old.
• Rheoencephalogram is a study of the venous outflow of the vessels of the brain.
• Computed tomography allows one to determine the size of the ventricles of the brain and the area of occlusion of the cerebrospinal fluid outflow.
• Fundus examination – determines the severity of deviations and the degree of the pathological process. In case of mild deviations – moderate venous congestion, in case of moderate deviations – individual hemorrhages, dilation and swelling of veins, severe deviations – hemorrhages, atrophy of the optic nerve papillae.

In addition to the above methods, cerebrospinal fluid diagnostics are performed. Deviations from the norm indicate intracranial hemorrhages, fresh erythrocytes and macrophages in the cerebrospinal fluid are possible.

Differential diagnosis

In its symptoms, the setting sun symptom is similar to other diseases that arise due to CNS disorders. Differential diagnostics allows us to separate the signs of the disease from other pathologies. HGS can be a symptom of hydrocephalus or any other neurological lesion. The differential examination includes clinical signs that indirectly indicate an increase in cerebrospinal fluid pressure and expansion of the ventricles of the brain.

• Particular attention is paid to the results of neurosonography. This method allows us to separate the symptoms of the disease from brain defects, hypoplasia, and haloprosencephaly.
• Computer tomography objectifies hypoxic changes in brain tissue in the structures of the cerebellum and brainstem, which are poorly defined by neurosonography.
• For differentiation, MRI is used to determine the degree of ventricular dilation, their multi-chamber nature, and the location of obstruction of the cerebrospinal fluid pathways.

Difficulties arise when examining children in the first year of life, since the presence of a fontanelle and open cranial sutures gives a certain erasure in the HGS clinic. A sharp increase in head circumference may be associated with the opening of the sutures and fontanelle. Additional symptoms allow one to suspect the disease: bulging fontanelle, dilation of veins of the scalp, convulsions, atrophy of the optic nerves, drowsiness, vomiting, crying, poor sucking and grasping reflexes. In some cases, a tense facial expression and a fixed position of the head are observed.

During the examination, it is taken into account that patients of any age may have transient fluctuations in cerebrospinal fluid and blood pressure. Headaches, nausea and other symptoms may indicate many functional and metabolic disorders of the brain, infectious or inflammatory diseases. A final diagnosis is possible by comparing clinical symptoms with diagnostic results that confirm the presence of changes in the size of the ventricles of the brain.

Treatment of Grefe syndrome

Treatment methods for Graefe syndrome depend on the diagnostic results. Neurosurgeons, neurologists, and ophthalmologists are involved in eliminating the disease. As a rule, treatment takes place in specialized neurological centers.

Treatment consists of:

• Drug therapy (diuretics, sedatives and vascular drugs, medicinal herbs).
• Diet
• Manual therapy
• Invasive procedures and gymnastics

Patients under 6 months are referred for outpatient treatment. Patients are prescribed drug therapy (diuretics, nootropics, sedatives), physiotherapy and massage. The therapy is long-term and takes 3-4 months. In older children and adult patients, treatment depends on the cause of the disorder. If the disease is the result of a neuroinfection, then antibacterial or antiviral therapy is carried out. In case of brain tumors or traumatic brain injuries, surgical intervention is indicated.

Medicines

Diseases of the central nervous system and brain require careful diagnostics and proper treatment. Not only health, but also the patient's ability to live a full life depends on the results of therapy. Medicines are selected by a doctor who is guided by the patient's age and the causes of the pathology.

Let's look at the main drugs used for Graefe's syndrome:

Diuretics that increase the outflow and decrease the secretion of cerebrospinal fluid.

1. Diacarb

Belongs to the pharmacological category of saluretics, causing diuresis by removing certain electrolytes. The drug is taken orally, and is detected in the blood after 6-12 hours. It is excreted unchanged by the kidneys within 24 hours.

• Indications for use: sodium and water retention in the body. Edema caused by circulatory failure, liver cirrhosis, renal failure, pulmonary-cardiac syndrome. Reduction of intraocular pressure, glaucoma (primary, secondary), epilepsy, pulmonary emphysema, tetany, gout.
• The drug is produced in the form of tablets that are taken orally. Patients are prescribed 100-250 mg 1-2 times a day. The course of treatment is 4-5 days. It is not used in diabetes mellitus, acidosis, Addison's disease, during pregnancy, hypochloruria, hypokalemia and hypochloremia.
• It is well tolerated, side effects occur when therapeutic doses are exceeded or due to prolonged use of the drug. Patients may experience attacks of drowsiness, dizziness, headaches, fatigue, allergic reactions. Symptomatic therapy is indicated for treatment.

If treatment with Diacarb is ineffective and there is a progressive enlargement of the ventricles of the brain, the patient is recommended to undergo hospitalization and bypass surgery.

Nootropics to improve blood flow to the brain.

2. Piracetam

Enhances dopamine synthesis in the brain, increases norepinephrine. Beneficial for blood circulation and metabolic processes in the brain, stimulates oxidation-reduction processes, improves blood flow, increases energy potential. The drug is available in the form of injections, for intravenous administration. The active substances quickly penetrate into various fluids and tissues of the body, including the brain. It is not metabolized, excreted by the kidneys, the half-life is 4 hours.

• Indications for use: pathological processes with cerebrovascular insufficiency. Changes in cerebral circulation, memory and attention disorders as a result of craniocerebral trauma. Neurotic and asthenoadynamic depressive states, schizophrenia, cerebrosthenic, encephalopathic disorders.
• The drug is administered intravenously, the initial dosage is 10 g in severe conditions up to 12 g per day. The duration of therapy is from 2 weeks to 6 months. Contraindicated in acute liver failure, diabetes, allergic reactions in the anamnesis, children under 1 year. In case of overdose, insomnia, irritability, heart failure appear.
• Side effects: decreased concentration, anxiety, mental agitation, dizziness and headaches, nausea, vomiting, diarrhea, convulsions, tremor. For treatment, it is necessary to reduce the dose of the drug and conduct symptomatic therapy.

3. Actovegin

By increasing the accumulation of glucose and oxygen, it activates cellular metabolism. This leads to an increase in the cell's energy resources and acceleration of the metabolism of adenosine triphosphoric acid. It increases cerebral blood circulation.

• Indications for use: acute cerebrovascular accidents, peripheral circulatory disorders, trophic disorders, ulcers of various etiologies, burns, radiation injuries. The medication is prescribed for damage to the cornea and sclera,
• The method of administration and dosage depend on the form of the drug and medical indications. Orally take 1-2 pills 2-3 times a day, for intravenous or intra-arterial administration use 10-20 ml. The course of treatment lasts 5-15 days. Actovegin is contraindicated in case of intolerance to its active components, during pregnancy and lactation.
• Side effects: skin allergic reactions, increased sweating, increased body temperature. To eliminate these symptoms, it is recommended to stop treatment and seek medical help.

4. Asparkam

It has an antiarrhythmic effect, regulates metabolic processes, restores electrolyte balance. It is a source of potassium and magnesium. It is used to treat and prevent hypokalemia and hypomagnesemia, with circulatory disorders, ventricular extrasystole, heart rhythm disorders, paroxysms of atrial fibrillation.

• The drug is available in the form of ampoules, tablets and infusion solution. Depending on the form of release, the doctor selects the dosage and duration of treatment (on average 8-10 days). Not used in chronic renal failure, myasthenia, hyperkalemia, hypermagnesemia, atrioventricular conduction disorders of 2-3 degrees.
• In case of overdose, signs of arterial hypotension, neuromuscular transmission disorders, arrhythmia, and convulsions occur. Side effects include attacks of nausea, vomiting, and diarrhea. Abdominal pain, flatulence, dry mouth, and increased sweating are possible. Hemodialysis and peritoneal dialysis are used for treatment.

Sedatives to normalize the functioning of the nervous system.

5. Diazepam

A benzodiazepine tranquilizer, has hypnosedative, anticonvulsant, anxiolytic and muscle relaxant properties. Selectively stimulates the action of gamma-aminobutyric acid in the receptors of the reticular formation of the cerebral column. This leads to a decrease in excitation of the limbic system, brain and thalamus. Increases the resistance of nerve tissues to hypoxia and the pain threshold, has a dose-dependent effect on the central nervous system.

• Indications for use: neurotic conditions (anxiety, hysteria, reactive depression), organic lesions of the central nervous system, insomnia, skeletal muscle spasms due to injuries, spastic conditions associated with damage to the brain or spinal cord. Complex treatment of vertebral syndrome, myositis, arthritis, bursitis, angina.
• The medicine is intended for oral use, regardless of food intake. The duration of therapy and dosage are selected individually for each patient. Increased dosages cause depression of cardiac activity, respiratory activity, agitation, and coma.
• Side effects are manifested by many organs and systems. Patients experience muscle weakness, emotional lability, decreased concentration. Possible bowel movements, nausea, vomiting, jaundice, skin allergic reactions. Diazepam can cause withdrawal symptoms and drug dependence.
• Contraindicated for use in case of intolerance to the active substances, tendency to myasthenia, suicide, epilepsy and epileptic seizures in the anamnesis. The drug is not prescribed for glaucoma, hepatitis, spinal and cerebral ataxia, cardiac and respiratory failure.

6. Tazepam

It has a hypnotic effect, has anticonvulsant and anxiolytic properties. Interacts with benzodiazepine receptors, causing their excitation. This provokes inhibition in the central nervous system, increasing the sensitivity of gamma-aminobutyric acid receptors. The active substances affect the reticular formation, reduce neurological symptoms.

• Indications for use: neurasthenia, anxiety, depression, restlessness, attacks of increased arousal, sleep disorders, tension during abstinence. Tablets are taken orally with clean water. Daily dosage is 15-30 mg, 3-4 times.
• Contraindications: intolerance to the active components of the product, glaucoma, dizziness, drug intoxication, coma, first trimester of pregnancy and lactation, respiratory failure, myasthenia, balance disorders.
• Side effects: drowsiness, increased fatigue, nausea, vomiting, diarrhea, dry mouth, insomnia, asthenia, muscle tremors, convulsions, impaired concentration, hypotension. To eliminate them, it is necessary to stop treatment and seek medical help.

The above-described medications are intended for long-term use to eliminate Graefe's syndrome. In severe attacks of the pathology, there is emergency treatment. The patient needs to raise his head at an angle of 30° and undergo dehydration therapy (1% lasix solution intramuscularly at a dose of 0.1 ml / kg per day, 25% magnesium sulfate solution intramuscularly at a dose of 0.2 ml / kg, diacarb and glycerin). In case of symptoms of decompensation, hospitalization in the neurological department is indicated.

Physiotherapy treatment

Therapy for hypertensive-hydrocephalic syndrome consists of many methods. This allows for a comprehensive approach to eliminating the pathological condition. Physiotherapeutic treatment consists of the following procedures:

1. Electrophoresis - the procedure is carried out with Euphyllin. The medicine is injected into the collar zone to improve the nutrition of the brain, which needs oxygen. The medicine normalizes the functioning of the brain vessels, ensuring normal absorption of lymph. As a rule, patients are prescribed 10 procedures for 15-20 minutes.
2. Acupuncture – normalizes metabolic processes and the functioning of the nervous system, eliminates vascular spasms.
3. Massage of the spine and cervical-collar zone – improves the outflow of venous blood from the cranial cavity. The course of therapy is 15-20 massages. Patients are prescribed daily self-massage 2 times a day for 20 minutes:

• Using your palms, insert up and down from the back of the head along the neck and collarbones.
• Massage the base of the skull using circular movements (the massage should cause moderate pain).
• Use your fingertips to make circular movements on the back of your head, stroking your neck.

4. Physiotherapy – swimming, race walking, tennis, walks in the fresh air. Thanks to the measured physical activity, the tone of the cervical-shoulder region increases, and muscle spasms go away. Compressed muscles can put pressure on the vessels that drain blood from the brain. The physiotherapist selects a set of exercises that improve the patient's well-being.
5. Magnet on the collar zone - such treatment procedures reduce vascular tone and normalize intracranial pressure. Magnets reduce the sensitivity of brain tissue to oxygen deficiency, which occurs due to excessive accumulation of cerebrospinal fluid. The magnet has an anti-edematous effect, reduces swelling of nerve tissue.
6. Circular shower – a special shower installation directs thin layers of water onto the skin, which activate receptors and have a temperature effect. Due to this, blood circulation improves, muscle tone increases.

Regular performance of physiotherapy procedures normalizes the patient's condition and allows to minimize the pathological signs of Graefe's syndrome.

Folk remedies

To eliminate diseases of the central nervous system, both traditional and non-traditional methods are used. Folk treatment is one of the latter. Such therapy is not approved by medicine, but in most cases it helps to minimize painful symptoms. Such treatment improves cerebral circulation, reduces the amount of cerebrospinal fluid (intracranial fluid) and relieves headaches.

Let's look at folk methods of treating the setting sun symptom:

• Tincture for restoring the central nervous system and improving cerebral circulation - mix equal proportions of valerian, hawthorn, mint, motherwort and eucalyptus leaves. Pour 500 ml of vodka over a tablespoon of the mixture and leave for 7-10 days at room temperature. Strain the product, squeeze it out and take 15-20 drops for 1-1.5 months.
• A remedy for reducing intracranial pressure - chop 2 lemons and a couple of cloves of garlic, put in a glass jar and pour 1.5 liters of hot water. The ingredients need to be mixed and infused during the day in a dark place at room temperature. Strain, squeeze and take 2 spoons 1 time per day before bed for 14 days.
• An infusion that lowers intracranial pressure: pour 20 g of lavender herb with 500 ml of boiling water and leave for 1-1.5 hours, strain and take 1 spoon once a day 30 minutes before meals for a month.

Traditional methods are best used with a doctor's consultation. They are not used for pediatric patients to avoid negative reactions from many body systems.

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Herbal treatment

Herbal therapy is one of the effective methods of normalizing the functioning of the central nervous system and other body systems. Herbal treatment is carried out under medical supervision. For Graefe syndrome, patients of all ages are prescribed herbs with a sedative effect. Most often, this is a cocktail of mint, hops, St. John's wort, sage and motherwort. The ingredients are mixed, infused and taken as needed. This remedy normalizes intracranial pressure.

Let's look at some popular herbal recipes:

• Grind the mulberry branches and pour boiling water over them. The decoction should be boiled over low heat for 30 minutes, cooled and filtered. Take 200 ml before meals.
• Grind the lavender herb and pour in olive oil 1:1. The medicine should be infused for 20 days in a dark, cool place. After that, it is filtered, mixed with Kalanchoe juice 1:1. The remedy can be dripped into the nose or taken orally 1-2 spoons.
• Mix nettle with succession in equal proportions and pour boiling water over it. The decoction should be consumed before each meal.
• Pour 500 ml of boiling water over dry plantain leaves and simmer for 10-15 minutes. Take the strained decoction 50 ml 3-4 times a day.
• Mix in equal proportions: dill seeds, nettle, knotweed, horse chestnut leaves and corn silk. Pour boiling water over the mixture and simmer for 10-20 minutes. After the remedy has cooled, strain it and take 10-20 ml before meals 2-3 times a day.

These recipes not only eliminate intracranial pressure, but also minimize the pathological symptoms of hydrocephalic disorder.

Homeopathy

Another method of alternative treatment of cerebrospinal fluid outflow disorders and the increased intracranial pressure caused by them is homeopathy. The drugs are selected by the attending physician, who examines the patient and studies his medical history.

Patients are prescribed only granulated remedies. As a rule, these are Apis 6 (3 granules regardless of food intake in the first half of the day) and Sanguinaria 6 (5 granules before bedtime). Therapy with homeopathic remedies is long-term, but allows achieving a lasting therapeutic effect.

Surgical treatment

Severe stages of Graefe syndrome, in which drug therapy is ineffective, require surgical intervention. There are several types of surgical treatment and they depend on the patient's age.

1. Bypass surgery

This method involves creating an additional path for the outflow of cerebrospinal fluid. The disadvantage of the operation is that if it is performed on children, then as they grow, it must be repeated.

• Indications: blockage of ducts, hydrocephalus, cysts, causing increased secretion of cerebrospinal fluid. The doctor performs intraculoperitoneal drainage of cerebrospinal fluid from the ventricles of the brain into the patient's abdominal cavity.
• The mechanism of action is that as soon as the pressure rises above the norm, a valve opens in the cranium, releasing excess cerebrospinal fluid into the tube system. The valve prevents the fluid from flowing back or blood from getting into it. Since the catheter has a small diameter, it can fail or become clogged, which will require its reinstallation.
• The procedure involves making a hole in the cranium and inserting a silicone catheter. One end of the tube is in the ventricle of the brain, and the other is brought out. A system of tubes and valves is provided to drain the cerebrospinal fluid, which is carried out under the skin.

2. Puncture

Allows to remove excess cerebrospinal fluid and normalize intracranial pressure. Provides outflow of cerebrospinal fluid from the ventricles of the brain, suitable for collecting fluid for analysis or administering medications.

• Ventricular - excess cerebrospinal fluid is removed through a long needle. The soft tissues of the head are cut and a small hole is made in the skull. A catheter is inserted through it to a depth of about 5 cm. As soon as it reaches the right lateral ventricle, it is attached to a special reservoir, which is fixed 20 cm above the head. This allows maintaining normal pressure levels and removing cerebrospinal fluid.
• Lumbar - the advantage of this type of surgery is that it has minimal risks of brain damage. The needle is inserted between the 2nd and 3rd lumbar vertebrae with a previously used solution of novocaine for anesthesia. Using a rubber tube, the cannula of the needle is connected to a reservoir to prevent bacteria from entering the spinal canal and the fluid is removed.

3. Endoscopic drainage surgery

• Indications – the need to remove the shunt mechanism or complications of shunt operations, post-traumatic increase in intracranial pressure. The doctor performs endoscopic perforation of the bottom of the third ventricle.
• The mechanism of action is to create a channel between the subarachnoid cisterns and the bottom of the ventricle using an endoscope. This operation does not cause complications and does not require repeated procedures.
• The course of the operation: a mechanism with micro-instruments (scissors, forceps, catheter) is used as an endoscope, which forms a channel for the outflow of cerebrospinal fluid in the bottom of the third ventricle into the cisterns of the brain.

Surgery is the only treatment for Graefe syndrome caused by congenital abnormalities, traumatic brain injury or tumors.

Prevention

After a course of treatment for hypertensive-hydrocephalic syndrome, the patient will have a long period of rehabilitation. Prevention is aimed at restoring the functioning of the central nervous system and normal intracranial pressure.

• Daily routine – it is very important to alternate different types of loads. Rest, i.e. sleep should be at least 7-8 hours. Avoid overheating, as elevated temperature leads to high blood pressure and increased production of cerebrospinal fluid. Raise the head of the bed by 30-40°, this will improve venous outflow from the cranial cavity.
• Physical activity – constant activity keeps the body in good shape. Child patients are recommended to visit the pool, walk more often in the fresh air. For adults – cycling, breathing exercises, yoga, fitness. Particular attention should be paid to massage, 20 minutes a day is enough to warm up stagnant neck muscles.
• Diet – rational balanced nutrition and drinking regime. It is necessary to drink 1.5-2 liters of purified water per day, eat small portions every 3-4 hours. The diet should contain a minimum of fatty, fried, salty food. Alcoholic drinks and confectionery products with trans fats are prohibited. Proper nutrition prevents obesity, which is the prevention of increased intracranial pressure.

Preventive measures must be followed throughout life. This will improve the general condition of the body and strengthen the immune system.

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Forecast

The sunset symptom, like any other CNS disease, has a favorable outcome with timely diagnosis and treatment. The prognosis depends on the stage at which the pathology was detected, the age of the patient and the individual characteristics of his body.

Graefe syndrome, left without medical care, leads to a number of complications that worsen the quality of life and prognosis for recovery. The negative consequences of the disorder can cause the patient's death or disability.

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